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General NPI Number Information
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NPI Number | 1205204807
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Entity Type | Organization
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Legal Business Name | REZVANI
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 09/13/2015
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Provider Practice Location Address
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Address Line | 17462 NORTHWEST FWY
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City | JERSEY VILLAGE
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State | TX
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Zip | 77040-1002
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Country | US
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Telephone | 713-224-5950
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Fax | 713-574-2704
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Provider Business Mailing Address
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Address Line | 17462 NORTHWEST FWY
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City | JERSEY VILLAGE
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State | TX
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Zip | 77040-1002
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Country | US
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Telephone | 713-224-5950
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Fax | 713-574-2704
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHABNAM REZVANI
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Credential | DDS
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Telephone | 713-224-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 27700
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License Number State | TX
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